| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address Salisbury Square #103Louisville, Kentucky Street Address PHONE NUMBER AVAILABLE CellUM Administration Coordinator 2 Humana Government Business (HGB) Street Address -Present18+ years of TRICARE experienceRespond to telephone and mail inquiries from beneficiaries and providers.Facilitate the timely and accurate resolution of initial denials of non-covered benefits and reconsideration reviews for TRICARE beneficiaries and providers.Facilitate preparation of DHA and NQMC cases for factual and medical necessity review at initial and reconsideration levels.Research all claims issues on case by case basis.Process physical and electronic mail to ensure proper work flow.Maintain federally mandated resolution timeframes and corporate standards for timeliness and quality.Facilitate effective working relationships with internal departments, TRICARE Market offices, and providers to ensure timely resolution of all cases. Grievance and Appeals Coordinator - Humana, Inc. 2015 2017Reviewed and sorted provider and member complaint, grievance and appeal submissions.Determined if G & A requirements were met, sorted appropriately, and set up appeals.Maintained compliance standards in sending acknowledgement letters. Government Inquiry Rep/Beneficiary Services Correspondent (HGB) 2005 2015Reviewed and responded to written inquiries from congressional, federal and legal entities, as well as beneficiaries and providers within federally mandated timeframes.Responded to TMA/DHA and other priority calls completely and accurately.Maintained extensive knowledge and comprehension of TRICARE program including contract requirements and appropriate federal regulations.Utilized excellent communication skills, both oral and written, to inform spectrum of customers on a priority basis.Researched to resolution debt collection issues for beneficiaries.Analyzed and identified issues as well as managed timeframes through independent work. Managed individual projects as assigned by Team Lead. Education and Training Centre College of Kentucky; BA-Government 1980 1984 CPT-4 and ICD-9 Training 1990 |
